First Name*

Last Name*

Contact Number*

Email*

PRODUCT AND PURCHASE DETAILS

Model Purchased*
Date Purchased*

Store where Purchased*


Purchase price of model (Must be same price as per receipt)*


Upload Receipt (Max 5 MB)*

Allowed file types gif,jpg, png and pdf

BANK DETAILS

IT IS THE CLAIMANT’S RESPONSIBILITY TO PROVIDE CORRECT BANK ACCOUNT DETAILS INCLUDING ACCOUNT NAME AS IT APPEARS ON YOUR BANK STATEMENT.
ANY CHARGES INCURRED DUE TO INCORRECT BANK DETAILS PROVIDED TO THE PROMOTER ARE THE CLAIMANT’S RESPONSIBILITY AND WILL NOT BE PAID FOR BY THE PROMOTER.

Bank Acccount Name*

BSB*

Bank Account Number*

Yes. I have read, understand and agree to the Terms and Conditions of this promotion.

Yes. I have read, understand and agree to the Privacy Policy of this promotion.